Marilyn Stringer, PhD, CRNP, RDMS, FAAN, Professor of Women’s Health Nursing
How does your work relate to global women’s health? Dr. Stringer begins by responding, “From the patient to the world.” She makes this statement in reference to the fact that her work takes on many forms, from her care for individual patients to her research that affects women globally. Within women’s health, her primary area of focus is the reduction of preterm birth. From training nurses in a novel skillset that they can use with their practice in another country, to her leadership roles bearing international implications, Dr. Stringer makes impressive hands-on contributions to the abstract notion of “global women’s health.”
In regards to her research Dr. Stringer states that her unique expertise is in limited obstetrical ultrasonography (LOBU). LOBU is an essential skillset for evaluating a fetus because it enables providers to assess the wellbeing of both the mother and her baby, while screening for preterm births. It was not until Dr. Stringer’s significant leadership with the practice of LOBU that advanced nursing practice to include this vital fetal assessment skill. In 2010, she was on a committee for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) whose purpose was to revise the AWHONN’s scope of practice guidelines to increase the scope of practice for obstetric and gynecologic ultrasonic assessment performed by nurses at the point of care. Dr. Stringer’s research continues to focus on the use of ultrasonic evaluations by nurses for the provision of timely assessments that promises to improve management strategies and patient outcomes.
What is the alternative to nurses not performing ultrasonic assessment? Dr. Stringer explains that without this skillset, nurses perform “fetal wellbeing studies” that do not include assessments such as fetal age and weight. As a consequence, nurses are forced to wait at the point of care for another trained provider to obtain the necessary assessments, or else refer the patient to an alternative provider. This delay in care may result in sub optimal patient outcomes.
However, thanks to a study directed by Dr. Stringer, evidence indicated that nurses receiving training in LOBU is both cost- effective and a productive use of nurses’ time. Through her strong nursing science research, it “made sense” to incorporate ultrasonography into the advanced practice nursing skillset. With her guidance, The School of Nursing’s curriculum for fetal assessment has been in place for 15 years now, and it has been shared with schools across the U.S. and internationally. In recounting the nature of the debate process when challenging current nursing scope of practice guidelines, Dr. Stringer teases, “You could teach nurses to be brain surgeons, but would that make sense?”
LOBU is one piece of Dr. Stringer’s work tied to global women’s health. Other highlights include her active role on the board of directors for the International Council on Women’s Health Issues (ICOWHI) and the 10 years she spent as the program director for the Women’s Health Nurse Practitioner (WHNP) program at the School of Nursing. ICOWHI is a multidisciplinary group (e.g. policy makers, urban planners, nurses, etc.) that serves two functions: (1) the publication of scholarly information and (2) a congress held every other year in varying host countries to highlight the women’s health issues of most importance to each given year’s specific host country. She remarks, “I would daresay this organization is leaving a footprint.”
Meanwhile, when discussing her work tied to the WHNP program, she mentions Nursing 535 as a course favorite. N535 is available to all nursing students, not just those in the WHNP program. It is a fieldwork study abroad program to lend cultural insight to health and health care delivery in Thailand. Dr. Stringer herself has had the privilege of accompanying students on this journey. She loves observing the back-and-forth learning that takes place between American and Thai students, and knows that both groups benefit in their healthcare delivery in their respective countries on account of their newfound knowledge and cultural sensitivity.
What are you currently working on? Dr. Stringer shares that she is currently working on an HPV grant called funded by the CDC. The research entails interviewing parents of girls between the ages of 11 and 14 to gather data related to the HPV vaccine: who initiates it, who goes on to complete it, and the barriers and assisting factors to receiving it. Then, after also talking with providers, her team plans to take all of the collected data and propose an intervention. Interestingly, Dr. Stringer comments that this work complements her focus on preventing preterm labor because of health issues like infectious disease processes are known to be precursors associated with preterm labor.
What girl or woman stands out in your mind as someone who has influenced you? First Dr. Stringer simply states, “Strong women,” because what comes to mind is not just one woman, but many. She begins by detailing women from her life of personal significance, including her grandmother, mother, and mother-in-law. She describes all of them as having very “can do” attitudes, despite having had no more than high school educations. She highlights that each of these three women embody what any of us mean when we describe somebody as a “strong person,” in speaking to inherent character rather than on-paper credentials.
She also mentions two women from professional relationships that have influenced her—Dr. Dorothy Brooten and Dean Afaf Meleis. Not only was Dr. Brooten on Dr. Stringer’s dissertation chair, but she served as Dr. Stringer’s role model as an expert nurse scientist recognized nationally and internationally. Dr. Stringer says that essentially, “Dr. Brooten set me on the road asking important questions to build the science of nursing.”
Of Dr. Meleis, Dr. Stringer speaks of the admiration she has for the Dean’s accomplishments at the School of Nursing over the past ten years, as somebody “empowering a global movement.” Dr. Meleis opened my eyes to exploring women’s issues not only in our adjacent community, but in the global community. There is much to learn and share between women from all parts of the world.